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Lindroth H, Byrnes T, Fuchita M, Hetland B, Liu K, Maya K, McAndrew NS, Mulkey MA, Nydahl P, Palakshappa J, von Haken R, Psoter KJ, Oh ES. Delirium in the United States: Results From the 2023 Cross-Sectional World Delirium Awareness Day Prevalence Study. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00067-3. [PMID: 38944277 DOI: 10.1016/j.jaclp.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/12/2024] [Accepted: 06/23/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Delirium is an acute brain dysfunction associated with an increased risk of mortality and future dementia. OBJECTIVES To describe the prevalence of clinically documented delirium in the United States on World Delirium Awareness Day 2023. METHODS This is a sub-analysis of a prospective, cross-sectional, online, international survey. All health care settings were eligible, with the exception of operating rooms and outpatient clinics. Health care clinicians, administrators, and researchers completed the survey. The primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. and 8:00 p.m. on March 15, 2023. Secondary outcomes were related to health care delivery. Descriptive statistics are reported. Differences between unit types (non-intensive care unit vs intensive care unit) were examined for all outcomes. RESULTS Ninety-one hospital units reported on 1318/1213 patients. The prevalence of clinically documented delirium was 16.4% (n = 216/1318) at 8:00 a.m. and 17.9% (n = 217/1213) at 8:00 p.m. (P = 0.316) and significantly differed between age groups, reported discipline, unit, and hospital types. Significant differences were identified between non-intensive care unit and intensive care unit settings in the use of delirium-related protocols, nonpharmacologic and pharmacologic management, educational processes, and barriers to evidence-based delirium care. CONCLUSIONS To our knowledge, this is the first epidemiologic survey of clinically documented delirium across two time points in the United States. Delirium remains a significant burden and challenge for health care systems. The high percentage of units using delirium management protocols suggests administrator and clinician awareness of evidence-based strategies for its detection and mitigation. We provide recommendations for future studies and quality improvement projects to improve clinical recognition and management of delirium.
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Affiliation(s)
- Heidi Lindroth
- Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN; Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, IN; Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN.
| | - Tru Byrnes
- Department of Nursing, Atrium Health-Carolinas Medical Center, Charlotte, NC
| | - Mikita Fuchita
- Division of Critical Care, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Breanna Hetland
- College of Nursing, University of Nebraska Medical Center & Critical Care Division, Nebraska Medicine Omaha, NE
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Institute for Molecular Bioscience (IMB), The University of Queensland, Brisbane, Queensland, Australia; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Kerri Maya
- Department of Continuing Professional Development, Sutter Health System, Sacramento, CA
| | - Natalie S McAndrew
- University of Wisconsin-Milwaukee, School of Nursing, College of Health Professions & Sciences, Milwaukee, WI; Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, WI
| | - Malissa A Mulkey
- Department of Biobehavioral and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC
| | - Peter Nydahl
- Nursing Research, University Hospital Schleswig-Holstein, Kiel Germany; Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria
| | - Jessica Palakshappa
- Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Kevin J Psoter
- Division of General Pediatrics, Department of Pediatrics, the Johns Hopkins University School of Medicine, Baltimore, MD
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Departments of Medicine, Psychiatry and Behavioral Sciences and Pathology, the Johns Hopkins University School of Medicine, Baltimore, MD; The Johns Hopkins University School of Nursing, Baltimore, MD
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Boss RD, Maddox K, Thorndike D, Keppel K, Batson L, Smith B, Weaver MS, Munoz-Blanco S. Building clinician-parent partnerships to improve care for chronically critically Ill children: A pilot project. PATIENT EDUCATION AND COUNSELING 2024; 122:108152. [PMID: 38232672 DOI: 10.1016/j.pec.2024.108152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Multicenter pilot to assess feasibility, acceptability, and educational value of videos for families and clinicians regarding unique inpatient challenges of pediatric chronic critical illness. METHODS Videos were developed for 3 hospitalization timepoints: 1) chronic critical illness diagnosis, 2) transfers, 3) discharge. Parents of hospitalized children, and interdisciplinary clinicians, were recruited to watch videos and complete surveys. RESULTS 33 parents (16 English-speaking, 17 Spanish-speaking) and 34 clinicians participated. Enrollment was better for families than clinicians (78% vs. 43%). Video acceptability was high: families and clinicians endorsed verisimilitude of depicted hospitalization challenges for chronic critical illness. All families felt the videos would help other families, all clinicians felt they would help other clinicians. Families gained expectations for the hospital course, discovered resources for hospitalization challenges, and learned there are other families in similar situations. Clinicians learned to recognize chronic critical illness, and how families experience hospitalizations, transfers, and discharges. CONCLUSION Educational videos about pediatric chronic critical illness were overall feasible, acceptable, and educational for hospitalized families and clinicians. PRACTICE IMPLICATIONS Just-in-time hospital education about pediatric chronic critical illness is valuable to families and clinicians; next steps are to assess potential to reduce gaps in care of children with chronic critical illness.
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Affiliation(s)
- Renee D Boss
- Johns Hopkins School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287 USA; Johns Hopkins Berman Institute of Bioethics, 1801 Ashland Ave, Baltimore, MD 21287 USA.
| | - Katherine Maddox
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Dorte Thorndike
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Kristopher Keppel
- Johns Hopkins School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Lora Batson
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Brandon Smith
- Johns Hopkins School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | | | - Sara Munoz-Blanco
- Johns Hopkins School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287 USA; The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
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Zhao Y, Missbrenner N, Xu HD, Josephson J. Enhancing delirium assessment and management through nursing education interventions: A scoping review. Nurse Educ Pract 2024; 75:103887. [PMID: 38245939 DOI: 10.1016/j.nepr.2024.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Abstract
AIM/OBJECTIVE The purpose of this scoping review was to explore the characteristics and outcomes of education interventions for nurses focused on delirium assessment and management. BACKGROUND Delirium is a prevalent acute and reversible neuropsychiatric syndrome in hospitalized patients. Delirium can cause cognitive, psychiatric and physical impairments and result in prolonged hospital stay, increased risk of readmission and elevated morbidity and mortality rates. Nurses play an essential role in managing delirium. There is a lack of understanding of the existing nursing educational interventions on delirium management. DESIGN The study was a scoping review. METHODS In this scoping review, we used Arksey and O'Malley's (2005) scoping review framework. We searched articles published between 2019 and 2023 in Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE using the following CINAHL/MeSH suggested subject terms: "delirium" in conjunction with "education" "intervention" and "nurse", "nurses" or "nursing." Studies on improving nursing knowledge and practices regarding delirium were included while those focusing on nursing students were excluded. Initial screening involved evaluating article titles and abstracts for relevance from 164 identified articles, followed by a full-text review of 42 articles. Finally, 17 articles were selected for comprehensive analysis. We extracted relevant information from each article and charted the findings in an evidence table. RESULTS The 17 selected articles showcased a variety of interventions used to educate nursing staff, such as workshops, simulations, group discussions, online modules and one-on-one coaching. Educational interventions primarily focused on delirium definition, risk factors, assessment and management. These educational interventions enhanced nurses' perception of delirium, boosting their confidence and knowledge in managing delirium. These interventions also led to increased compliance with delirium assessment and management protocols, which ultimately resulted in improved documentation accuracy and patient outcomes. CONCLUSIONS Findings from this scoping review suggest that nursing administration need to provide support and education for delirium prevention and management to enhance nursing staff confidence and competence in assessing and managing delirium. The use of interactive educational techniques has demonstrated profound benefits in schema development, expertize promotion and critical thinking. These findings have significant implications for future research, including the identification of essential nursing competencies for educational interventions and the assessment of long-term knowledge retention and its application in nursing practice.
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Affiliation(s)
- Yunchuan Zhao
- School of Nursing, Boise State University, 1910 University Drive, Mail Stop 1840, Boise, ID 83725, United States.
| | - Nicolette Missbrenner
- School of Nursing, Boise State University, 1910 University Drive, Mail Stop 1840, Boise, ID 83725, United States
| | - H Daniel Xu
- Department of Political Science, East Carolina University, 1000 E 5th Street, Mail Stop 564, Greenville, NC 27858, United States
| | - Jayne Josephson
- School of Nursing, Boise State University, 1910 University Drive, Mail Stop 1840, Boise, ID 83725, United States
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Zhou W, Zheng Q, Huang M, Wang J, Gan X. Development and validation of nurse's assessment ability questionnaire in delirium subtypes: Based on Delphi expert consensus. PLoS One 2024; 19:e0297063. [PMID: 38261557 PMCID: PMC10805299 DOI: 10.1371/journal.pone.0297063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Delirium, a common occurrence in clinical work, can be divided into three subtypes according to Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition (DSM-5). Each subtype has its special significance and focus. As the primary caregivers and observer of delirious patients, nurses should be able to quickly and accurately indentify each subtype. Therefore, it is necessary to clarify nurses' assessment ability of delirium subtypes. However, there is currently no suitable questionnaire available for investigating nurses' assessment ability of delirium subtypes. OBJECTIVE To develop a scientifically validated questionnaire for assessing nursing assessment ability of delirium subtypes based on Knowledge-Attitude-Practice(KAP) Model. METHODS The questionnaire was conducted from October 2021 to February 2022 to assess the KAP status of nurses the regarding delirium subtype. A two-round Delphi Method was employed to revise the draft questionnaire, ensuring the importance and rationality of each item. Ten experts specializing in critically ill patients, clinical nursing, and nursing management were invited from seven provinces in China for the Delphi process. Additionally, we validated the reliability and validity of the questionnaire. RESULTS The return rate in the first and second rounds were 83% and 100%, respectively. The individual authority coefficients for the two rounds of correspondence ranged from 0.787 to 0.987, while the overall authority coefficient of experts was 0.866. Kendall's coefficient of coordination for the importance scores were found to be 0.192 and 0.156, respectively, whereas those for rationality scores were calculated as 0.149 and 0.141, respectively. Notably, all mean values of importance and rationality scores in the two rounds were exceeded a threshold of 4.10 across both rounds of assessment with coefficient variations (CV) ranging from 0.00 to 0.19 for importance ratings and 0.00 to 0.16 for rationality ratings, both of which were <0.25. Experts proposed modifications to eleven items while introducing four new ones into consideration during this process; thus ensuring that reliability and validity standards were met by the final questionnaire design which consists of a total of thirty-seven items distributed across four dimensions: delirium subtype-related knowledge, assessment attitude, assessment practice, and knowledge source-thereby establishing its clinical relevance as a reliable scientific instrument. CONCLUSION The development process is both scientific and theoretical, encompassing reliable expert correspondence results and a diverse range of question formats. As thus, effectively captures the current landscape of delirium subtypes assessment among clinical nurses from multiple perspectives, including knowledge level and source, attitude, assessment behavior, and assessment barriers. It offers comprehensive and detailed insights.
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Affiliation(s)
- Wen Zhou
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Second Department of Nursing School, Chongqing Medical University, Chongqing, China
| | - Qiulan Zheng
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Second Department of Nursing School, Chongqing Medical University, Chongqing, China
| | - Miao Huang
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Second Department of Nursing School, Chongqing Medical University, Chongqing, China
- Basic Department of Nursing School, Chongqing Medical University, Chongqing, China
| | - Jiao Wang
- Joint Surgery Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuni Gan
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Makhija H, Fine JM, Pollack D, Novelli F, Davidson JE, Cotton SA, Diaz De Leon B, Reyes PA, Montoya JL, Arroyo-Novoa CM, Figueroa-Ramos MI, Song Y, Fuentes AL, LaBuzetta JN, Moore AA, Ely EW, Malhotra A, Needham DM, Martin JL, Kamdar BB. Development and Validation of an ICU Delirium Playbook for Provider Education. Crit Care Explor 2023; 5:e0939. [PMID: 37457918 PMCID: PMC10348729 DOI: 10.1097/cce.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Although delirium detection and prevention practices are recommended in critical care guidelines, there remains a persistent lack of effective delirium education for ICU providers. To address this knowledge-practice gap, we developed an "ICU Delirium Playbook" to educate providers on delirium detection (using the Confusion Assessment Method for the ICU) and prevention. DESIGN Building on our previous ICU Delirium Video Series, our interdisciplinary team developed a corresponding quiz to form a digital "ICU Delirium Playbook." Playbook content validity was evaluated by delirium experts, and face validity by an ICU nurse focus group. Additionally, focus group participants completed the quiz before and after video viewing. Remaining focus group concerns were evaluated in semi-structured follow-up interviews. SETTING Online validation survey, virtual focus group, and virtual interviews. SUBJECTS The validation group included six delirium experts in the fields of critical care, geriatrics, nursing, and ICU education. The face validation group included nine ICU nurses, three of whom participated in the semi-structured feedback interviews. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 44-question quiz had excellent content validity (average scale-level content validity index [S-CVI] of individual items = 0.99, universal agreement S-CVI = 0.93, agreement κ ≥ 0.75, and clarity p ≥ 0.8). The focus group participants completed the Playbook in an average (sd) time of 53 (14) minutes, demonstrating significant improvements in pre-post quiz scores (74% vs 86%; p = 0.0009). Verbal feedback highlighted the conciseness, utility, and relevance of the Playbook, with all participants agreeing to deploy the digital education module in their ICUs. CONCLUSIONS The ICU Delirium Playbook is a novel, first-of-its-kind asynchronous digital education tool aimed to standardize delirium detection and prevention practices. After a rigorous content and face validation process, the Playbook is now available for widespread use.
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Affiliation(s)
- Hirsh Makhija
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Janelle M Fine
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Daniel Pollack
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
| | - Francesca Novelli
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
- School of Nursing, Oregon Health and Science University, Ashland, OR
| | - Judy E Davidson
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Department of Psychiatry, UCSD Health, San Diego, CA
| | - Shannon A Cotton
- Nursing Education & Development Research Department, UCSD Health, San Diego, CA
- Critical Care Unit, UCSD Health, San Diego, CA
| | - Bianca Diaz De Leon
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Paola Alicea Reyes
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | | | - Yeonsu Song
- School of Nursing, University of California, Los Angeles (UCLA), Los Angeles, CA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Ana Lucia Fuentes
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | | | - Alison A Moore
- Division of Geriatrics, Gerontology and Palliative Care, UCSD Health, San Diego, CA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
| | - Dale M Needham
- Division of Pulmonary & Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
- School of Nursing, Johns Hopkins University, Baltimore, MD
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA
- UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD) Health, San Diego, CA
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